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Treating Bladder Problems
When the person you are caring for has been diagnosed and knows what is causing their bladder problem, you will be able to discuss possible treatments with their doctor or continence advisor. They will explain what is causing the problem and how the different treatments can help. They will also discuss any potential side effects and, together, you can decide which treatment is the most suitable.
Once diagnosed, the person you are caring for is likely to first be offered what are known as conservative treatments, sometimes in conjunction with medicines depending on their symptoms and medical history. Surgery is a final option and will not normally be considered until other treatments have been tried for a length of time without success.
Please bear in mind that the treatment information on this site is provided as a general guide only and you should always consult a Doctor or Healthcare Professional to discuss which treatment options may be suitable for the person you are caring for.
There are many types of conservative treatments that the person you are caring for may be offered, a selection of the most common are listed below.
Biofeedback is a technique which is designed to strengthen the urethral and pelvic floor muscles to help gain control over the bladder. It can help in learning which muscles to use, when to use them and how hard to contract them to prevent leakage.
How does biofeedback work?
There are several different types of biofeedback methods but a common one is where a probe is inserted into the vagina (for women) or back passage (for men). The pressure exerted onto the probe when the muscles are squeezed (as if you were trying to avoid passing water) will be displayed on a computer screen.
A physiotherapist or specialist nurse will instruct the person you are caring for how and when to squeeze their muscles to provide effective control over their bladder. At first they will practice using the screen as a guide and then the screen will be hidden from view so that they have to try it for themselves.
Over time, they should gain more co-ordination and control over their pelvic floor muscles. The strength of these muscles will also be improved as they are exercising them during the biofeedback programme.
Another form of biofeedback is the use of real-time ultrasound scanning. A probe is placed on the perineum and a picture of the pelvic organs is seen on a screen. As the pelvic floor muscles are squeezed the person you are caring for is able to see what happens around their bladder. A physiotherapist or specialist nurse will be able to correct how the muscles are squeezed.
Bladder retraining is a simple and often effective method used to try and overcome bladder problems.
How does bladder retraining work?
Bladder retraining helps people to begin to hold more urine for longer periods of time. It is possible to train the bladder to do this by gradually increasing the time between each visit to the toilet.
This method sounds simple; however bladder retraining takes time and determination and will not work overnight. To have a chance of successful bladder retraining the person you are caring for must try to ignore the feeling that they need to go to the toilet for as long as possible.
If they can learn to ignore the feeling that they need to go straight away, their bladder will begin to relax and will become less irritable. Eventually, it is possible for them to be in control of their bladder - and not the other way round.
To help identify their bladder habits and patterns, it is worth starting a bladder diary to record the amount of times they visit the toilet, how long the gaps are between visits and what/how much they drink.
From the diary they will be able to identify how long their bladder can hold on until it needs to be emptied and this allows them to set realistic goals that can help their bladder become stronger.
Tibial Nerve Stimulation
Percutaneous Tibial Nerve Stimulation (PTNS) can be used to treat some cases of Overactive Bladder problems where symptoms of urinary urgency, urinary frequency and urge incontinence have not been resolved by other treatments.
PTNS is designed to indirectly stimulate the nerves responsible for bladder control. This treatment acts on the tibial nerve as it passes around the ankle and targets the nerves in the spinal cord that control the function of the pelvic floor called the sacral nerve plexus. A small, fine needle is inserted near the tibial nerve at the ankle and this is connected to a stimulator device. The impulses travel along the nerve pathways and help to retrain your bladder function, thereby alleviating your symptoms of incontinence.
- Medicines can help many of the symptoms of urinary incontinence and are often used in conjunction with more conservative therapies.
- Anticholinergics are used to treat urge urinary incontinence and are often used in conjunction with bladder retraining. They can also help problems caused by an overactive bladder such as frequently needing the toilet during the night or passing urine while asleep.
- Desmopressin is a medicine sometimes used for night-time urine problems.
- Vaginal oestrogens can be useful for an overactive bladder if the cause proves to be oestrogen deficiency - for example in women who are past the menopause.
- Duloxetine hydrochlorideis a medicine that can help Stress Urinary Incontinence if symptoms are more severe. It may be combined with pelvic floor muscle exercises.
- Solifenacin Succinateis a medicine used to help treat symptoms of an overactive bladder. It works by preventing spasms of the bladder muscle, which can help to reduce the episodes of urinary incontinence or reduce the feeling of urgency that bladder spasms can cause.
Surgery is usually viewed as a final option and will not normally be considered until other treatments have been tried for a length of time without success.
Tension Free Vaginal Tape
Tension-free vaginal tape (TVT) is often used for women with stress urinary incontinence. It is usually not considered suitable for women considering having children, or for women with certain other medical conditions.
During the operation the tape is inserted through a small incision in the vaginal wall. It lies between the vagina and the urethra, so it supports the middle of the urethra. Each end of the tape is threaded through two small holes on the abdomen just above the pubic bone. This support reduces the effect of any sudden increase in abdominal pressure (coughing, sneezing, laughing) that causes incidences of stress incontinence.
Sacral Nerve Stimulation
Nerve stimulation by a treatment called Sacral Neuromodulation can help some people control their overactive bladder. It involves a small device being surgically implanted just beneath the skin in the upper buttock. A thin wire is implanted in the lower back and connected to the device. This device acts as a battery and stimulates the appropriate nerves via the implanted wire by using mild electrical impulses.
By doing this, it can help restore coordination between brain, pelvic floor, bladder or bowel and sphincter muscles.
Injectable Therapies are a less invasive treatment option and an alternative to major surgery. They are often suitable for those who are reluctant to have surgery, or who are planning to have more children. In this therapy, bulking agents are injected into the wall of the urethra to improve the closure mechanism of the bladder neck and this treatment is often used for Stress Urinary Incontinence.
Treating Bowel problems
When the person you are caring for has been diagnosed and knows what is causing their bowel problem, you will be able to discuss possible treatments with their doctor or continence advisor. They will explain what is causing the problem and how the different treatments can help. They will also discuss any potential side effects and, together, you can decide which treatment is the most suitable.
Once diagnosed the person you are caring for is likely to first be offered what are known as conservative treatments, sometimes in conjunction with medicines depending on their symptoms and medical history. Surgery is a final option and will not normally be considered until other treatments have been tried for a length of time without success.
Biofeedback is a conservative treatment often used for faecal incontinence and constipation. It is used and supervised by a healthcare professional to help the person you are caring for carry out sphincter muscle exercises correctly.
A small electric probe is placed into the rectum and the sensors in the probe relay information about the movement and pressure of the muscles in the rectum to a computer. The results are displayed on the computer screen. The person you are caring for will be asked to squeeze their sphincter muscles and the pressure will be measured by sensors in the probe. Viewing the results on the computer screen will help them squeeze in the right way. With practice, the person you are caring for should get to know when to squeeze their sphincter muscles to prevent leaks or, if they have constipation, how to correctly relax the muscles when attempting to empty the bowels. This method of treatment should help improve bowel function and should help the person you are caring for to perform their exercises in the right way.
Bowel retraining is a simple and often effective method used to try and overcome bowel problems such as recurring constipation, diarrhoea or incontinence.
If the incontinence is due to a lack of anal sphincter control or decreased awareness of the urge to defecate, the person you are caring for may benefit from a bowel retraining programme aimed at helping them restore muscle strength. In some cases, bowel retraining means learning to go to the toilet at a specific time of day. This helps them gain greater control by establishing, with some predictability, when they need to use the toilet. It may also mean training the bowels not to open so frequently by gradually increasing the time between each visit to the toilet.
To help identify their bowel habits and patterns it is worth starting a bowel diary, recording the amount of times they visit the toilet, how long the gaps are between visits and what/how much they eat.
From the diary they may be able to identify any factors that are contributing to their bowel problems.
- Sometimes, doctors recommend medications to treat faecal incontinence, such as:
- Anti-diarrhoeal drugs: The doctor may recommend medications to reduce diarrhoea and help the person you are caring for avoid faecal incontinence. Many of these are available over the counter from pharmacies.
- Laxatives: If chronic constipation is to blame for incontinence, the doctor may recommend the temporary use of mild laxatives to help restore normal bowel movements.
- Stool softeners: To prevent stool impaction, the doctor may recommend a stool-softening medication.
- Other medications: If diarrhoea is the cause of the faecal incontinence, the doctor may recommend drugs that decrease the spontaneous motion of the bowel or medications that decrease the water content of the stools.
If damage to the external anal sphincter has been diagnosed, surgical repair may be an option. This operation consists of a cut in front of the anus. The surgeon will then overlap the damaged muscle ends to form a complete ring of muscle around the anus.
Treating rectal prolapse
A rectal prolapse can be repaired and the rectum fixed back in place. There are two ways to repair the prolapse, either by a repair through the anus without external incision or through an incision in your abdomen (nowadays this can be done with 4 or 5 very small incisions instead of one large incision across the lower abdomen).
An artificial sphincter can be used to replace a damaged anal sphincter. The device is essentially an inflatable cuff, which is implanted around the anal canal. When inflated, the device keeps the anal sphincter shut tight until the bowels are ready to empty.
Sacral Nerve Simulation
This can help some people who experience bowel problems such as incontinence and chronic constipation.
It involves a small device being surgically implanted just beneath the skin in the upper buttock. A thin wire is implanted in the lower back and connected to the device. This device acts as a battery and stimulates the appropriate nerves via the implanted wire by using mild electrical impulses.
By doing this, it can help restore coordination between brain, pelvic floor, bladder or bowel and sphincter muscles.
Using Incontinence Pads
Incontinence products are used as a short term treatment option or as part of an on-going overall management plan for individuals who do not wish more active treatment (or when these active treatments are ineffective in restoring full continence). Products should not be used as an alternative to other treatment options but rather as additional support. A wide variety of products are available to help manage incontinence, whilst maintaining dignity and an acceptable quality of life.
It is important that the person you are caring for receives the continence products that are most suitable to them and a thorough assessment of their needs is crucial to achieve this.
- A number of factors need to be taken into consideration when a Healthcare Professional makes an assessment for the provision of incontinence products and these may include:
- The type of incontinence
- Physical and mental condition
- Personal hygiene levels
- Skin condition and local anatomy
- Personal preference and perception of need
- Support Services
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